We pay the Minimum Benefits for restricted services – including the minimum default benefit rate for a shared room as is set out by the government and for government-approved Prosthesis List items.

So if you decide to be looked after:

In a private hospital – you’ll be out-of-pocket, as the benefits we pay won’t cover all the hospital costs

In a public hospital as a private patient – you could still have out-of-pocket expenses to pay, if the minimum benefit is less than what your hospital charges.

Either way, the hospital should let you know about any out-of-pocket expenses you’ll need to pay. This is called informed financial consent.

Excluded servicesThese are the services that you aren’t covered for – so if you use any of them, you’ll have out-of-pocket expenses.

ExcessYou won’t need to pay an excess with StarterPak.

Waiting PeriodsLike all health funds, we have a waiting period between when you take out your cover and when you can access the benefits of that cover.

Waiting periods apply to:

Members taking our health insurance for the first time

Current Teachers Health members who upgrade to a higher level of cover, or reduce their cover or excess

Members who come over to Teachers Health from another health fund who haven’t finished the waiting periods – or are transferring to higher cover.

If you’ve cancelled your membership with another health fund, you’ll need to join us within 60 days to keep up your cover.

Hospital Waiting Periods

Pre-existing conditions*

12 months

Pregnancy & birth related services

9 months

Psychiatric, rehabilitations & palliative care

2 months

All other hospital services

2 months

Emergency ambulance transport

1 day

Non-emergency ambulance transport

1 day

*A pre-existing condition is an illness, ailment or condition where the signs or symptoms of which, in the opinion of the Fund Medical Advisor or other relevant medical practitioner appointed by Teachers Health, existed at any time during the six months before taking out private health insurance or transferring to a higher level of cover. This rule applies to new members to private health insurance and existing members who are upgrading their level of cover. If you are a new member to private health insurance you will have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition. If you change to a higher level of cover, you may have to wait 12 months to receive benefits, including benefits for services not previously covered. A 12 month waiting period applies to all pre-existing conditions except pregnancy & birth related services, which is a 9 month waiting period and psychiatric, palliative care and rehabilitation, which is a two month waiting period.

Extras Waiting Periods

Orthodontia

24 months

Wheelchair purchase

24 months

Major dental, medical appliances

12 months

Optical, healthy lifestyle

6 months

All other services

2 months

Emergency ambulance transport

1 day

Make sure you claim with a recognised provider

We can only pay benefits if you’ve taken up the service through a provider who’s recognised by Teachers Health at the time. To find out if your provider’s one of them, just call us on 1300 727 538.